What doctor / midwife appointments should I make during pregnancy?

The recommended schedule of appointments varies throughout pregnancy. Up to the 32nd week of your pregnancy you can visit your health care provider (midwife or gynecologist) every four weeks. Between the 32nd week and your estimated due date antenatal care visits are recommended every two weeks. If the estimated date of delivery (EDD) has passed, then appointments every two days are offered.

What happens during these appointments?

During every appointment standardized health checks and screenings as well as an assessment of your overall wellbeing are made. More precisely, your midwife calculates your actual week of pregnancy, measures your blood pressure, tests your urine and blood, asks about perceived changes in your body, palpates your womb, estimates the size and position of your baby, listens to the fetal heartbeat and addresses any concern you might have.

What are the differences between appointments at a gynecologist and a midwife during my pregnancy?

The content and procedures should be similar with both a gynecologist and a midwife to ensure the best possible quality of care. The main difference is that midwives are not trained to offer ultrasounds. Both midwives and gynecologists are obligated to provide a check-up and help ensure a healthy pregnancy. The role of the midwife is to monitor the healthy pregnancy and transfer any suspicious finding to a medical specialist for obstetrics. Midwives traditionally have a more physiological approach to the pregnancy, whereas doctors sometimes tend to look for health risks. At the doctor’s office routine checks (e.g. blood pressure, urine and blood testing) are usually done by medical assistants as there is less time allocated to each patient. Homebirth midwives usually work independently, therefore you will most likely have your pregnancy visits at your own home. This ensures a continuity of care with regard to the planned homebirth.

What can help me determine where I would like to give birth?

I think it is important to think about how you imagine giving birth in the optimal surrounding for you. Moreover it is advisable to book a consultation with a midwife who will be unbiased and unprejudiced when assessing your values and needs. Talking to friends and family can often lead to uncertainty or adaptation of other people’s values and fears. When deciding about the place of birth, women with a healthy, “low risk” pregnancy have to think about how they define safety: By the presence of medical and surgical equipment and highly specialized personnel, or by the continuity of care with a healthy physiological approach in their own space and time.

If I decide on a homebirth, how do I go on about it?

It is recommended to contact a homebirth midwife as soon as you find out that you are pregnant. In Germany midwives are eligible to confirm your pregnancy as well as to issue the maternal health passport (Mutterpass). Together you will schedule your ongoing prenatal care plan. You are free to decide whether you want to visit your midwife, your gynecologist, or both alternately. Especially in the later stages of your pregnancy it is recommended that you meet your midwife more often to better get to know each other and establish a relationship of trust. Throughout your physiological pregnancy journey your midwife will help you and your partner to prepare for your homebirth.

How does homebirth happen and how does it differ from giving birth in a hospital?

One simple difference is: when labor begins, women are able to just stay at home and don’t need to go to a hospital. More importantly, at home you have the continuity of carer, which means, that you will have 1:1 support by your midwife – with whom you’ve built a relationship. Many midwives work in teams of two, so that there are two extra skilled helping hands when needed. Homebirth midwives are specialized in the art of knowing when to do “nothing” by allowing, supporting and monitoring the physiological progress of labor and birth and detecting any deviations early. They maintain a protected environment shielding the mother from unnecessary interventions.

In comparison, midwives at hospitals work in shifts and due to increasing workload they have to take care of up to five women in labor at the same time. Limited time, forensic pressure and understaffing often leads to unnecessary and harmful interventions. On the other hand, birth in a hospital is the best option for pregnant women with health issues who need specialized medical care during birth.

What are the costs involved in giving birth?

The German public health insurance covers the costs of all necessary appointments during pregnancy, birth and post partum. When it comes to homebirth, midwives charge a fee for being on call 24/7 during five weeks around your EDD. This fee varies between EUR 350- EUR 1000 per midwife and region. Most health insurances subsidize this on call fee with up to EUR 300. Furthermore, you might be charged for any “extras”, e.g. renting a birth pool, acupuncture, etc.

What do I need to prepare for a homebirth? Do I need special equipment?

Homebirth midwives bring all medical equipment needed when it comes to birth. You only need a warm, safe room, where you can comfortably rest after birth. In addition to that, you will have a consultation with your midwife and anyone else you want to accompany you during birth, where you will discuss anything you need to prepare for the big day. This may include a good light source if suturing is necessary, a bowl for the placenta, a plastic covering sheet to protect your sofa, garbage bags, etc.

Are there other factors I have to include?

Some women are concerned about their neighbors or are afraid that somebody might hear them while in labor. First of all: It is your right to have a homebirth if you so choose! You don’t need to talk with every neighbor first, but it might be helpful to place a notice on your door advising that you will be having a homebirth when the day comes. Regarding the noise, there is nothing to worry about. Homebirths tend to be calmer than those in a hospital. Besides, it is as normal as having louder sex :-)

What pain relief is available for me during home birth?

During a homebirth women have a mutual trust with their midwife and feel safe to dedicate themselves to labor. This alone allows the body to release a very special mixture of hormones and natural opioids, which help to cope better with the increasing intensity of labor. Therefore, most of the time little or no medical anesthesia is needed. Midwives are allowed to work with mild analgesic and anticonvulsant medicine but not with centrally acting opioids, due to possible adverse effects on the newborn. Massage, water immersion, loving touch from the partner, meditation, breathing and relaxation techniques, together with respect to the natural progress of birth are most healthy and effective.

Where can I educate myself about the risks and statistics?

Even when planning a homebirth, when a transfer and medical staff is needed, the next clinic needs to be reachable in no more than 30 minutes. Please look up the data from QUAG, the german society for quality in out-of-hospital obstetric care. On this website you can find the yearly summaries of birth outcomes. For example, 3,4% of all mothers had to be transferred to a hospital after a home birth in 2016.

In the unlikely event of an emergency happening during or after a homebirth, midwives are trained to provide emergency aid as well as advanced life support for the mother and the newborn. Homebirth midwives carry emergency medicine and medical oxygen to every birth and are required to complete a significant level of annual education in obstetric emergencies, advanced life support, suturing, etc.

Which books can help me prepare better for home birth?

Michel Odent statet that:

“I usually claim that pregnant women should not read books about pregnancy and birth. Their time is too precious. They should, rather, watch the moon and sing to their baby in the womb.”

Reading books may satisfy the logical brain but during birth the “mammalian brain” is activated. Therefore every woman should look out for books that appeal to her personally.

How often do I see my postpartum midwife and what should I expect from these visits?

Homebirth midwives cover long distances to provide care. Therefore they cannot offer postpartum home visits to every woman whose birth they have attended. Instead they advise you early in pregnancy to contact another postpartum midwife. Public health insurers cover up to twenty postpartum home visits within the first ten days after giving birth. Up to three months after birth you can have up to sixteen more consultations. Furthermore, you can still receive consultation from your midwife regarding breast-feeding and the introduction of solid foods up to the first year of your baby’s life.